GERD Risk Assessment Questionnaire

  • Do you currently smoke cigarettes, or not?
  • Are you more than 10% above your ideal bodyweight?
  • Do you eat out often?
  • Do you get frequent heartburn or chest pains (especially after eating)?
  • Do you suffer from indigestion, burping, nausea after eating, or stomach bloating?
  • Do you face difficulties in breathing or swallowing?
  • Do you often feel hoarseness in your throat primarily in the morning?
  • Do you suffer from a chronic cough?
  • Are you prone to dental cavities or enamel erosions?
  • Do you experience regurgitation or vomiting reflex often?

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